Harmful effects—documentation subthemes and illustrative quotations
| Subtheme | Quotation (Participant (P)) |
| 1. FIT gaming indirect harm: fudge withdrawal time | ‘That’s always one of the things that you worry about is are you just going to take off a load of rectal polyps in the same way that you could just withdraw and sit in the rectum for five minutes, couldn't you, and then say your withdrawal times.’ (P3) |
| ‘When it comes to withdrawal times … some people will say, “Start the clock,” and then [the nurses] say well, “Are you actually at the caecum?” … some endoscopists who had then kind of hung around the rectum for a couple of minutes saying, “I’m staying here around the rectum for a couple of minutes because I have to”.’ (P5) | |
| ‘Of course, you have to be wary of withdrawal time. I hear anecdotally from the nurses that: “So and so has a long withdrawal time but eight minutes of that [they are] sitting in the rectum talking”.’ (P19) | |
| 2. FIT gaming indirect harm: conversion to sigmoidoscopy | ‘People have changed what was an intended colonoscopy to a flexi sig because of poor prep or that’s as far as they’ve got and you can see the nursing documentation, the original referral.’ (P7) |
| ‘I know some people kind of falsify figures and I always put if it’s a colon it’s a colon. If it’s a failed colon it’s a failed colon. It’s not a sigmoidoscopy it’s a colonoscopy and I know that people do not always follow that… That skews the figures as well… It’s very common.’ (P10) | |
| 3. FIT gaming indirect harm: bowel preparation | ‘I do understand that some endoscopists could potentially fudge their figures and are feeling tired, “oh poor bowel prep, let’s just come out”. So I do understand that, so I don’t know what the answer is but it is hard because you do get poor bowel preps.’ (P12) |
| ‘My caecal intubation rate is lower than it should be perhaps, mainly because of poor bowel prep.’ (P2) | |
| ‘Well part of the problem with [detection rates] is some that will be down to poor prep. I can think of a number of cases recently where the prep in the right colon is fairly smeary. If you had better prep, you’d probably have [detection].’ (P19) | |
| 4. FIT gaming—TPB control belief: comfort | ‘There’s no consistency with regard to whether the data is the endoscopist’s personal view or whether it’s they have taken feedback from the nurses in the room talking to the patient.’ (P5) |
| ‘I was signing off a colonoscopy portfolio for somebody for JAG certification and I just said, “You’ve done your 230 or whatever.” I said, “Why is everyone of your patients comfortable?” … I hadn’t done individual training with this person. And I just thought, “Oh my God. What on earth.” They said, “Well that’s what the consultant’s put on the thing.”… But it just wasn’t important to him. I just thought, oh my goodness, throughout his training, where has that perception come from. And I was really worried … I said, “I’m not signing you off until you go back and we do some more work and have a look at sort of these comfort scores with patients and whatever.” But it was through no fault of their own in some ways but I was absolutely horrified.’ (P7) | |
| ‘Comfort has been such a difficult thing … every unit does it differently, newer nurses will call your patients as higher discomfort because they’ve never seen the procedures before …we’ve got everybody using different nursing scales.’ (P7) |
FIT, feedback intervention theory; JAG, Joint Advisory Group; TPB, theory of planned behaviour.